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General NPI Number Information
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NPI Number | 1740587427
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Entity Type | Organization
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Legal Business Name | PERFORMANCE HEALTH AND WELLNESS
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 204 S PARK ST
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City | BRENHAM
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State | TX
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Zip | 77833-3646
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Country | US
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Telephone | 979-451-9111
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Fax |
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Provider Business Mailing Address
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Address Line | 204 S PARK ST
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City | BRENHAM
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State | TX
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Zip | 77833-3646
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Country | US
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Telephone | 979-451-9111
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. RHEAGAN KHRISHA MULDER
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Credential | D.C.
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Telephone | 979-451-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11430
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License Number State | TX
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